Effectiveness of galvanic vestibular evoked myogenic potential for evaluation of Meniere's disease

Abstract Objectives: Although the cause of Meniere's disease (MD) is not fully understood, endolymphatic hydrops is widely believed to be responsible for MD. Previous studies have used Air-Conducted Sound (ACS)-induced Vestibular Evoked Myogenic Potentials (VEMPs) to evaluate otolithic function in patients with MD. However, the use of Galvanic Vestibular Stimulation-VEMPs (GVS-VEMPs) with other vestibular tests in MD has been rare. This study aimed to explore the application of galvanic VEMPs in assessing MD. Methods: Normal individuals and patients with unilateral definite MD were included in this retrospective study. All participants underwent pure tone audiometry. Ocular and cervical VEMPs induced by GVS, and ACS were recorded. The characteristic parameters of VEMPs (n1 latency, p1 latency, amplitude, and AR) were analyzed. Results: The provocation rates of GVS-VEMPs did not differ between MD patients and control individuals. Compared with ACS, GVS could evoke potentials with longer latencies. MD patients presented GVS-VEMPs with lower amplitudes and ACS-cVEMP with shorter latencies and had a higher response rate in GVS-oVEMP. However, no differences or correlations were found in the characteristic parameters of GVS-VEMPs among the different stages of MD. Conclusions: GVS is as effective as ACS for inducing VEMP, and GVS-VEMP recording can detect retrolabyrinthine degeneration in MD. Further research is needed to assess the utility of GVS-VEMP in the evaluation of MD severity. Level of evidence: Level 4.

Aging and wave-component latency delays in oVEMP and cVEMP: a systematic review with meta-analysis / Envelhecimento e os atrasos nas latências das componentes de onda no oVEMP e no cVEMP: uma revisão sistemática com metanálise

Abstract Introduction: The natural aging process may result in morphological changes in the vestibular system and in the afferent neural pathway, including loss of hair cells, decreased numbers of vestibular nerve cells, and loss of neurons in the vestibular nucleus. Thus, with advancing age, there should be a decrease in amplitudes and an increase in latencies of the vestibular evoked myogenic potentials, especially the prolongation of p13 latency. Moreover, many investigations have found no significant differences in latencies with advancing age. Objective: To determine if there are significant differences in the latencies of cervical and ocular evoked myogenic potentials between elderly and adult patients. Methods: This is a systematic review with meta-analysis of observational studies, comparing the differences of these parameters between elderly and young adults, without language or date restrictions, in the following databases: Pubmed, ScienceDirect, SCOPUS, Web of Science, SciELO and LILACS, in addition to the gray literature databases: OpenGrey.eu and DissOnline, as well as Research Gate. Results: The n1 oVEMP latencies had a mean delay in the elderly of 2.32 ms with 95% CI of 0.55-4.10 ms. The overall effect test showed p = 0.01, disclosing that such difference was significant. The heterogeneity found was I 2 = 96% (p < 0.001). Evaluation of p1 latency was not possible due to the low number of articles selected for this condition. cVEMP analysis was performed in 13 articles. For the p13 component, the mean latency delay in the elderly was 1.34 ms with 95% CI of 0.56-2.11 ms. The overall effect test showed a p < 0.001, with heterogeneity value I 2 = 92% (p < 0.001). For the n23 component, the mean latency delay for the elderly was 2.82 ms with 95% CI of 0.33-5.30 ms. The overall effect test showed p = 0.03. The heterogeneity found was I 2 = 99% (p < 0.001). Conclusion: The latency of oVEMP n1 wave component and latencies of cVEMP p13 and n23 wave components are longer in the elderly aged >60 years than in young adults.

Resumo Introdução: O processo natural de envelhecimento pode resultar em mudanças morfológicas no sistema vestibular e na via neural aferente, inclusive perda de células ciliadas, diminuição do número de células do nervo vestibular e perda de neurônios no núcleo vestibular. Dessa forma, com o avanço da idade, deveria ocorrer diminuição nas amplitudes e aumento nas latências dos potenciais evocados miogênicos vestibulares (VEMP), principalmente o prolongamento da latência p13. Além disso, muitos artigos não encontraram diferenças significativas nas latências do VEMP com o avanço da idade. Objetivo: Analisar se existem diferenças significativas para as latências do VEMP cervical (cVEMP) e do VEMP ocular (oVEMP) entre idosos e adultos. Método: Revisão sistemática com metanálise de estudos observacionais que comparam diferenças desses parâmetros entre idosos e adultos jovens, sem restrições de idiomas ou datas, nas seguintes bases de dados: Pubmed, ScienceDirect, Scopus, Web of Science, SciELO e Lilacs. Além das bases de literatura cinzenta OpenGrey.eu e DissOnline e ainda no Research Gate. Resultados: As latências n1 do oVEMP tiveram um atraso médio nos idosos de 2,32 ms com IC 95% 0,55-4,10 ms. O teste para o efeito geral obteve p = 0,01 e revelou que tal diferença foi significativa. A heterogeneidade encontrada foi I2 = 96% (p < 0,001). Avaliação da latência de p1 não foi possível devido ao baixo número de artigos selecionados para essa condição. A análise do cVEMP foi feita com 13 artigos. Para o componente p13, o atraso médio para as latências dos idosos foi de 1,34 ms com IC 95% 0,56-2,11 ms. O teste para o efeito geral obteve p < 0,001; com valor da heterogeneidade I2 = 92% (p < 0,001). Para o componente n23, o atraso médio para as latências dos idosos foi de 2,82 ms com IC 95% 0,33-5,30 ms. O teste para o efeito geral obteve p = 0,03. A heterogeneidade encontrada foi I2 = 99% (p < 0,001). Conclusão: A latência do componente de onda n1 do oVEMP e as latências dos componentes de onda p13 e n23 do cVEMP são mais prolongadas em idosos com idade > 60 anos do que em adultos jovens.

Assessment of Balance and Vestibular Functions in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 华中科技大学学报（医学）（英德文版）

This study investigated the relationship among the severity of hearing impairment,vestibular function and balance function in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).A total of 35 ISSNHL patients (including 21 patients with vertigo) were enrolled.All of the patients underwent audiometry,sensory organization test (SOT),caloric test,cervical vestibular-evoked myogenic potential (cVEMP) test and ocular vestibular-evoked myogenic potential (oVEMP) test.Significant relationship was found between vertigo and hearing loss grade (P=0.009),and between SOT VEST grade and hearing loss grade (P=0.001).The abnormal rate of oVEMP test was the highest,followed by the abnormal rates of caloric and cVEMP tests,not only in patients with vertigo but also in those without vertigo.The vestibular end organs were more susceptible to damage in patients with vertigo (compared with patients without vertigo).Significant relationship was found between presence of vertigo and SOT VEST grade (P=0.010).We demonstrated that vestibular end organs may be impaired not only in patients with vertigo but also in patients without vertigo.The cochlear and vestibular impairment could be more serious in patients with vertigo than in those without vertigo.Vertigo does not necessarily bear a causal relationship with the impairment of the vestibular end organs.SOT VEST grade could be used to reflect the presence of vertigo state in the ISSNHL patients.Apart from audiometry,the function of peripheral vestibular end organs and balance function should be evaluated to comprehensively understand ISSNHL.Better assessment of the condition will help us in clinical diagnosis,treatment and prognosis evaluation of ISSNHL.

The Feasibility and Effectiveness of the Simultaneous Recording of Ocular and Cervical Vestibular-evoked Myogenic Potentials / 听力学及言语疾病杂志

Objective To study the feasibility of simultaneously recording ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP) by combined oVEMP and cVEMP tests.Methods Twenty healthy volunteers and twenty-three patients with Meniere's disease were admitted and underwent combined oVEMP and cVEMP tests in a random order,and individual oVEMP and cVEMP tests on another day.The results of combined and individual oVEMP and cVEMP tests were compared.Results For twenty healthy volunteers in oVEMP and cVEMP tests,the 100％ response rate were observed in the both combined and individual test modes.The differences in amplitudes and latencies and interaural amplitude difference were insignifi-cant.For twenty-three patients with Meniere's disease,the results of oVEMP/cVEMP for the affected and unaffected ears failed to sow any significant differneces,regardless of the individual or combined mode.Conclusion The simultaneous recording of oVEMP and cVEMP by the combined mode has similar results to that obtained by individual mode for both healthy or unilateral vestibular hypofunction.Simultaneous oVEMP and cVEMP tests may be a convenient screening test and deserves further clinical applications.

Application of ocular vestibular evoked myogenic potentials in acute brainstem infarctions / 中华物理医学与康复杂志

Objective To explore the value of ocular vestibular evoked myogenic potential in treating brainstem infarctions through comparing the characteristics ocular vestibular evoked myogenic potential (oVEMP) and brainstem auditory evoked potential (BAEP) in patients with brainstem infarctions.Methods A total of 60 patients with brainstem infarctions were enrolled in a brainstem infarction (BI) group, while another sixty healthy volunteers were selected as the control group.All patients underwent oVEMP and BAEP tests via air-conducted stimuli.Results The oVEMPs were elicited reliably and stably in 58 of the control group, and 42 of the BI group, with the bilateral N1 and P1 latencies of oVEMP significantly prolonged [N1 (left) : 11.85 ± 0.82 ms, N1 (right) : 11.91 ± 0.86 ms, P1 (left) : 15.52 ± 1.61 ms, P1 (right) : 15.63 ± 1.64 ms respectively] and the bilateral N1-P1 amplitudes of oVEMP significantly reduced [1.23 ±0.42 μV (left) and 1.58 ± 0.70 μV (right) respectively].Moreover, no recordable oVEMPs was elicited in the other 18 patients, among which found 13 prolonged N1 latencies, 10 prolonged P1 latencies, 6 prolonged N1 and P1 latencies and 8 reduced N1-P1 amplitudes of oVEMP.Altogether, 45 abnormal oVEMPs were found, with an abnormal rate of 75％.The average peak latencies of Ⅴ waves [(5.98 ± 0.37) ms] and interpeak latencies of Ⅲ-Ⅴ and Ⅰ-Ⅴ waves [2.93 ± 0.34 ms and 4.96 ± 0.39 ms respectively] in the BI group were significantly prolonged compared to the controls (P＜ 0.01).The amplitude ratio of Ⅴ/Ⅰ (0.48 ± 0.10) in the BI group was significantly reduced compared to the controls (P ＜ 0.05).Forty-two abnormal BAEPs were found, with an abnormal rate of 75％ , including 17 prolonged latency of Ⅴ waves, 6 prolonged latency of Ⅲ waves, 15 prolonged interpeak latencies of Ⅲ-Ⅴ waves, 9 prolonged interpeak latencies of Ⅰ-Ⅴ waves, 11 cases of Ⅲ-Ⅴ interpeak latency larger than Ⅰ-Ⅲ interpeak latencies, 13 cases of the amplitude ratio of Ⅴ / Ⅰ smaller than 0.5 and 3 case of unclear waves.There were no significant differences in abnormal rate when using the oVEMP (42/60 and 75％) and BAEP (45/60 and 70％) testing However, the abnormal rate was 91.7％ when combining oVEMP with BAEP testing, significantly higher than that when only conducting BAEP testing.Conclusion Patients with brainstem infarctions have abnormalities in oVEMP.Combined with MRI and other electrophysiological testing, oVEMP may contribute to the diagnosis of brainstem infarctions.

Ocular Vestibular Evoked Myogenic Potentials Produced by Stimulation With Bone-conducted Vibration in Healthy Subjects / 대한평형의학회지

BACKGROUND AND OBJECTIVES: To provide the empirical basis for using ocular vestibular evoked myogenic potentials (oVEMPs) in response to bone-conducted vibration (BCV) stimulation to indicate vestibular function in normal subjects. MATERIALS AND METHODS: In response to bone-conducted tone burst (90 dB nHL and 100 dB nHL with frequencies 500 Hz and 1,000 Hz, the oVEMPs were measured in 45 healthy controls. The early negative component (n10) of the oVEMP to brief BCV of the forehead and at each mastoid process is recorded by surface electromyography electrodes just beneath the eyes. We used a hand-held vibrator (Bruel and Kjaer 4810 Mini-Shaker) placed on the forehead, in the midline at the hairline (Fz) and at each mastoid process and quantified the individual differences in n10 magnitude, latency and symmetry to Fz and mastoid BCV at each frequency. RESULTS: In normal subjects, n10 responses were symmetrical in the two eyes during Fz and both mastoid stimuli and the latencies of the onset were consistent among subjects. Response rate is similar between Fz and mastoid stimuli. However, at each stimulation site, response rate is higher on 500 Hz than on 1,000 Hz stimulation. During the mastoid stimuli, the onset latency is slightly shorter and amplitude is larger than the Fz stimuli. The average amplitudes decreased with age and average latency (to peak) increased slightly with increasing age. CONCLUSION: Clear oVEMP responses to bone-conducted Fz and mastoid stimuli were evoked from normal subjects. It is concluded that bone-conducted stimuli as well as air conduction can evoke myogenic potentials from the ocular muscles.